Treatment of the hidden penis in boys

Abstract

Introduction. “Hidden penis” (HP) is a developmental malformation of the penis characterized by normally developed, but abnormally located cavernous bodies in the surrounding tissues of the symphysis or scrotum, manifested by the visually shortened penis trunk. The most common type is «buried» penis (BP). This pathology requires, as a rule, surgical treatment.Purpose. To assess outcomes of BP treatment with an improved surgical technique.Material and methods. 40 boys, aged from 2 to 16 (average age 9 ± 1.59) and diagnosed with HP, were treated in 2014-2019. BP was diagnosed in 35 children (87.5%), webbed penis (WP) – in five (12.5%). Primary BP was in 18 children (51.4%) and BP in combination with the suprapubic obesity - in 17 patients (48.6%). Two children (5%) were operated after the previous circumcision. Indications for surgery were: congenital primary HP, secondary HP in adolescents with insufficient visualization of the penis, psychological discomfort of the patient and the absence of significant clinical effects after conservative care. The average age of children with primary HP was 3.9 ± 2.48; with secondary HP and pubic obesity - 12 ± 3.84 years. During surgery, circular or circular and ventral midline incisions to the middle of the scrotum were used; they were followed by mobilization of the penis from adhesions, excision of adipose tissue in the bosom, fixation of the pubopenile and penoscrotal angles with a non-absorbable surgical thread. The authors have proposed a new technique for foreskin fixation using 2 ventral and 2 dorsal incisions, through which the skin was sutured to the deep fascia of the penis to prevent its distal slipping.Results. All patients had good anatomical and functional results. The authors describe the developed surgical technique in details; they also make literature review on the discussed problem.Conclusion. In the treatment of HP an improved surgical technique with the additional use of incisions allows you to reliably fix the skin of the foreskin on the trunk of the penis, avoiding its distal displacement.